Comparative Effectiveness Research

A new demonstration project shows that public deliberation is a promising way to obtain people's informed opinion about complicated health care issues. AHRQ, like many organizations interested in improving health, would like to capture the public voice on complex and value-laden health issues for which the "off-the-cuff" responses obtained through surveys and focus groups are not always appropriate.

In public deliberation, members of the public are given balanced information on an issue and then convened to discuss the information, learn from others, examine and refine their own views, and give their opinions. The demonstration shows the public's capacity to apply evidence, view health care issues from a societal perspective, and often to prioritize societal needs over personal needs. Deliberative methods are feasible and effective, and they have similar effects across the spectrum of race, ethnicity, age, and educational attainment.

Several types of deliberative methods were tested and compared with a group who were given reading materials but did not meet for discussion. The deliberative methods varied in the size of the group, whether facilitation was active or minimal, whether meetings were in person or online, the number of meetings, and cost.

All the deliberative methods were effective, but less intensive methods may be more suited to less complex topics.Compared with the reading-only group, members of all deliberative methods groups combined gained knowledge of medical issues and concepts related to health care, using medical evidence, and comparative effectiveness research, and demonstrated a shift in attitudes on a number of subjects.

One purpose of the deliberative methods demonstration project was to obtain informed public views about questions central to the mission of AHRQ's research programs regarding appropriate and acceptable ways to use evidence. Topics included the tradeoffs in seeking care at a hypothetical regional versus lower-performing local hospital; use of inappropriate antibiotics for upper respiratory infection, and the link between inappropriate antibiotic use and methicillin-resistant Staphylococcus aureus; the relevance of evidence in choices for treating coronary artery disease; and obesity management.

The participants had strong core values of individual freedom and personal choice, which were tempered in varying degrees by concern for the greater good and perceptions of fairness. Evidence of physical or economic harm to some individuals or the community led to increased acceptance of some limits on decisionmaking. Members of the public respect research evidence but express concerns about its limitations.

The Deliberative Methods Demonstration Project is part of the AHRQ Community Forum, whose purpose is to improve and expand public and stakeholder engagement in AHRQ's Effective Health Care Program.